Associate Medical Director – Orthopedic Spine Surgery
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Costa Mesa • California • New York • United States
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Salary
💰 $179 - $280 per hour
Job Level
About the role
- Determines the medical necessity of requests using clinical criteria
- Performs physician-level case review of musculoskeletal utilization requests
- Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service
- Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments
- Performs first level provider appeals of coverage decisions
- Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management
- Participates in physician team meetings
- Participates in groups that develop, revise and enhance clinical appropriateness guidelines
Requirements
- Requires MD/DO and Board certification by the American Board of Neurologic Surgery or American Osteopathic Board of Neurosurgery
- American Board of Orthopedic Surgery with completion of fellowship training in Spine Surgery or American Osteopathic Board of Orthopedic Surgery with completion of fellowship training in Spine Surgery also meets the Board certification requirements for this position
- Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s) required
- Experience performing standard neurosurgical spine procedures independently
- Minimum of 3 years of clinical practice experience past fellowship training preferred
- Extensive spine surgery experience preferred
- Experience with utilization management, especially with CMS guidelines preferred.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- merit increases
- paid holidays
- Paid Time Off
- medical benefits
- dental benefits
- vision benefits
- short term disability benefits
- long term disability benefits
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical criteriamusculoskeletal utilization requestspeer-to-peer consultationsurgical proceduresimagingprovider appealsmusculoskeletal diagnosestreatmentsmanagementneurosurgical spine procedures
Soft Skills
educationcommunicationteam collaborationconsultationsupport
Certifications
MDDOBoard certification by the American Board of Neurologic SurgeryAmerican Osteopathic Board of NeurosurgeryAmerican Board of Orthopedic Surgeryfellowship training in Spine SurgeryAmerican Osteopathic Board of Orthopedic Surgeryunrestricted medical license